Scheifele D W, Dobson S, Kallos A, Bjornson G, Ochnio J J
Vaccine Evaluation Center, BC's Children's Hospital, University of British Columbia, Vancouver, Canada.
Pediatr Infect Dis J. 1998 Dec;17(12):1121-6. doi: 10.1097/00006454-199812000-00004.
Tetanus-diphtheria toxoids (Td) booster immunization is generally recommended for Grade 9 students (14- to 16-year-olds) but targeting younger students may enhance vaccine uptake or facilitate simultaneous vaccinations. However, earlier vaccination might cause greater side effects. This study was undertaken to compare the safety of Td vaccinations in students in Grade 6 (11 to 12 years old) and Grade 9.
A controlled, sequential assessment of Td vaccine, adsorbed, was conducted in one urban school district, starting with Grade 9 students. Grade 6 students were given Td concurrently with Dose 3 of hepatitis B vaccine. Adverse effects were assessed during visits 2 days after vaccination. Participation criteria, immunization technique and assessment procedures were standardized.
Of 410 students vaccinated, 204 in Grade 9 and 206 in Grade 6, 391 (95.4%) were assessed in person. Nineteen missed follow-up visits but telephone interviewers established that none missed school because of vaccine side effects. At follow-up Grade 6 students more often reported deltoid pain with arm movement (35.2% vs. 10.8%, P < 0.001). Injection site redness > or = 50 mm in diameter was present in 12.2% of Grade 6 and 3.6% of Grade 9 students (P < 0.001) whereas swelling > or = 50 mm diameter was present in 22.4 and 10.8%, respectively (P < 0.01). Fewer than 10% of subjects took analgesics for injection site pain. Only 5 students (1.3%) rated Td site morbidity as severe/unacceptable. Hepatitis B site morbidity was minimal in comparison.
Td boosters were moderately reactogenic in adolescents. Younger students more often experienced injection site morbidity but considered it bearable. Booster immunizations can reasonably be offered within the age range of 11 to 16 years.
破伤风-白喉类毒素（Td）加强免疫通常推荐给九年级学生（14至16岁），但针对更年幼的学生进行接种可能会提高疫苗接种率或便于同时接种其他疫苗。然而，更早接种疫苗可能会导致更严重的副作用。本研究旨在比较六年级（11至12岁）和九年级学生接种Td疫苗的安全性。
在一个城市学区对吸附破伤风疫苗进行了对照、序贯评估，从九年级学生开始。六年级学生在接种乙肝疫苗第3剂的同时接种Td疫苗。在接种疫苗2天后的随访中评估不良反应。参与标准、免疫技术和评估程序均标准化。
在410名接种疫苗的学生中，九年级204名，六年级206名，391名（95.4%）接受了当面评估。19名学生错过随访，但电话访谈确定无人因疫苗副作用缺课。随访时，六年级学生更常报告三角肌在活动时有疼痛（35.2%对10.8%，P<0.001）。六年级12.2%的学生和九年级3.6%的学生注射部位出现直径≥50mm的红肿（P<0.001），而直径≥50mm的肿胀分别为22.4%和10.8%（P<0.01）。不到10%的受试者因注射部位疼痛服用镇痛药。只有5名学生（1.3%）将Td疫苗接种部位的不适评为严重/不可接受。相比之下，乙肝疫苗接种部位的不适极小。
Td加强疫苗在青少年中反应原性中等。年幼学生更常出现注射部位不适，但认为可以忍受。在11至16岁年龄范围内合理地提供加强免疫接种是可行的。
